"Type 2 Diabetes Mellitus and the Patient-Provider Relationship"

Purpose: According to the CDC 23.6 million, 7.8% of the population, have diabetes (CDC). Individuals with diabetes are at a higher risk for serious health complications which increase morbidity and mortality. Previous studies have confirmed that this morbidity and mortality can be reduced with effective medical care. There is little data on the association between the patient provider relationship and control of chronic disease states such as diabetes. The purpose of this study is to evaluate the relationship between patient perceived empathy in the patient provider relationship and diabetic control as measured by HbA1C.

Materials and Methods: Five-hundred subjects were randomly selected from a registry of over 6,000 diabetic patients from a mid-west multi-centered family practice. Inclusion criteria included a HbA1C at least one year prior to the study, >18 years of age, and a diagnosis of Type 2 diabetes for at least one year. Information obtained through a computerized query included patient gender, most recent A1C value, and information regarding the patient provider (name, education, gender and number of years of practice). Subjects were mailed the CARE survey, a validated tool used to assess empathy in the patient-provider relationship, along with a self addressed stamped envelope to return the survey.

Results: Seventy eight (16%) of the surveys were returned with eight surveys excluded because the subjects indicated they had Type 1 diabetes. 33(47%) of the surveys were from males and 37(53%) from females. Age range for males was 40 to 86 years(61 mean) and for females was 36 to 91 years(66 mean). Fourth, providers were identified: 36 MDs, and 4 DOs. Of the 40 patient providers, 31 were male and 9 were female. Male providers managed the care of 29(90%) of the male subjects and 21 (66%) of the female subjects, whereas, female providers managed the care of 3(10%) of the male subjects and 11(34%) of the female subjects. In the total sample HbA1C values ranged from 5.3 to 12.4% (mean 6.9%). The range of A1C for males was 5.4 to 10.4 %( mean 7.0%) and for females was 5.3 to 12.4% (mean 6.9%). The results of the CARE survey revealed a range of 19 to 50 with a mean score of 44.32 (a perfect score of 50 indicates an excellent empathy score). A linear regression model created using CARE survey scores of 45 or greater and scores less than 45 resulted in significant predictors of HbA1C scores and length of relationship (p=0.053), diabetes duration (p=0.022), length of provider practice (p=0.017), gender of provider (p<0.001), provider gender + patient age (p<0.001), and provider gender +diabetes duration (p=0.004). Further analysis identified that there is a decrease in A1C with increased age, increase in A1C with increased diabetes duration and having a female provider increases HbA1C by 0.776.

Conclusion: Overall the subjects rated their provider with a high empathy score. Only when the CARE survey score was stratified by a great score (45 or greater) and less than great score(<45) did we find predictors of HbA1C values (length of relationship, diabetes duration, length of provider practice, gender of provider, provider gender + patient age, and provider gender + diabetes duration). Other findings indicated that HbA1C is lower with increasing age, increased with diabetes duration and increased when cared for by a female provider.